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Secondary Analysis of Pain Outcomes in a Large Pragmatic Randomized Trial of Buprenorphine/Naloxone Versus Methadone for Opioid Use Disorder. J Addict Med 2021; 14:e188-e194. [PMID: 32039934 DOI: 10.1097/adm.0000000000000630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Opioid use disorder (OUD) is associated with chronic pain. We investigated the association between medication treatments for OUD and pain in a post-hoc secondary analysis of a randomized trial of methadone versus buprenorphine/naloxone. METHODS 1241 individuals with OUD participated in an open label, pragmatic randomized trial of methadone versus buprenorphine/naloxone in nine treatment programs licensed to dispense agonist medication for OUD between 2006 to 2009. In this post-hoc analysis, pain was dichotomized (present or not present) using responses from the Short Form-36. Logistic regression models were fit to test the effect of (1) having baseline pain on week 24 retention, (2) treatment assignment on improvement in pain among those reporting pain at baseline, and (3) pain improvement at week 4 on week 24 retention among those reporting pain at baseline. RESULTS Almost half (48.2%) of the sample reported pain at baseline. Participants with baseline pain did not significantly differ in week 24 retention compared to those without baseline pain. Among those reporting pain at baseline, there was no significant difference between treatment arms in improvement of pain at week 4, but improvement in pain at week 4 was associated with significantly greater odds of being retained at week 24 (OR [95% CI] = 1.76 [1.10, 2.82], P = 0.020). CONCLUSION AND RELEVANCE In this large multisite randomized trial of medication treatments for OUD, nearly half of the participants reported pain at baseline, and improvement in pain early in treatment was associated with increased likelihood of retention in treatment.
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Pain Sensitivity, Negative Affect, and Alcohol Use Disorder Status: A Moderated Mediation Study of Emotion Dysregulation. J Clin Med 2021; 10:jcm10061321. [PMID: 33806849 PMCID: PMC8005076 DOI: 10.3390/jcm10061321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022] Open
Abstract
Previous work suggests that the association between pain and emotional processes among individuals with alcohol use disorder (AUD) may differ from healthy controls. This study investigates whether pain sensitivity mediates the association between negative affect and emotional dysregulation and whether this association differs across AUD status using moderated mediation. The sample included 165 individuals diagnosed with AUD and 110 healthy controls. Of interest was pain sensitivity, as assessed with the Pain Sensitivity Questionnaire, negative affect, as assessed with the Beck Depression Inventory, and emotional dysregulation, as assessed with the Difficulties in Emotional regulation Scale. Age, biological sex, and current pain severity were included as covariates. The results support a moderated partial mediation model that explained 44% of the variance in emotional dysregulation. The findings indicate that negative affect is related to higher pain sensitivity across groups. Moreover, pain sensitivity partially mediated the association between negative affect and emotional dysregulation, but in opposite directions depending on AUD status. Among healthy controls, greater pain sensitivity was related to better emotional regulation, while greater pain sensitivity led to greater emotional dysregulation among individuals with AUD. The potential parallels in the underlying neurobiological mechanisms of emotionality, pain, and AUD suggest that interventions targeting pain may improve adaptive affect regulation skills, which in turn could reduce negative affect and its effect on pain sensitivity among individuals with AUD.
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Ilgen MA, Coughlin LN, Bohnert ASB, Chermack S, Price A, Kim HM, Jannausch M, Blow FC. Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:1225-1234. [PMID: 32725178 PMCID: PMC7391182 DOI: 10.1001/jamapsychiatry.2020.2369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Chronic pain is common in those with substance use disorders (SUDs) and predicts poorer addiction treatment outcomes. A critical challenge for addiction treatment is to develop effective methods to improve pain-related and substance use-related outcomes for those in treatment for SUDs. OBJECTIVE To examine the efficacy of an integrated behavioral pain management intervention (Improving Pain During Addiction Treatment [ImPAT]) for men and women with SUDs to treat pain, functioning, and substance use. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, 8 sessions of ImPAT were compared with 8 sessions of a supportive psychoeducational control (SPC) condition for adults with pain treated at a large residential SUD treatment program. Follow-up occurred at 3, 6, and 12 months postbaseline. A total of 1372 adults were screened, including 960 men and 412 women, and 510 adults were randomized, including 264 men and 246 women. The goal was to recruit approximately equal numbers of men and women to examine results separately in men and women. A total of 470 of 510 participants (92.2%) completed at least 1 follow-up assessment. Data were collected from October 3, 2011, to January 14, 2016. Data were analyzed from February 1, 2016, to May 1, 2020. INTERVENTIONS ImPAT focused on how a psychosocial model of pain was associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and involved discussions of topics like nutrition and the course of addiction, which were intended to be relevant to the patient population and to have face validity but be distinct from the content of ImPAT. MAIN OUTCOMES AND MEASUREMENTS The primary outcomes were pain intensity, pain-related functioning, and behavioral pain tolerance at 12 months. Secondary outcomes were frequency of alcohol and drug use over 12 months. RESULTS Of the 510 included participants, the mean (SD) age was 34.8 (10.3) years. A total of 133 men and 122 women were assigned to ImPAT, and a total of 131 men and 124 women were assigned to the SPC condition. Over 12 months of follow-up, randomization to the ImPAT intervention was associated with higher tolerance of pain among men, higher by a mean score of 0.11 (95% CI, 0.03 to 0.18; P = .004; Cohen d = 0.40) at 3 months and by 0.07 (95% CI, -0.01 to 0.19; P = .11; Cohen d = 0.25) at 12 months. Women receiving the ImPAT intervention experienced a reduction in pain intensity from 3 to 12 months, while women receiving the SPC condition experienced an increase in pain intensity, resulting in lower pain in the ImPAT condition by a mean score of 0.58 (95% CI, -0.07 to 1.22; P = .08; Cohen d = -0.22) at 12 months. No differences were found between the ImPAT and SPC conditions on alcohol or drug use. CONCLUSIONS AND RELEVANCE Behavioral pain management is not typically included in addiction treatment, but the present results indicate that this type of intervention was associated with better pain-related outcomes, including pain tolerance in men and pain intensity in women. Improvements in substance use-related outcomes beyond that achieved by treatment as usual were not observed. Treatment programs should consider providing psychosocial pain management services to augment standard addiction treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01372267.
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Affiliation(s)
- Mark A. Ilgen
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Stephen Chermack
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Amanda Price
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - H. Myra Kim
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Mary Jannausch
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Frederic C. Blow
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
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Barry DT, Beitel M, Cutter CJ, Fiellin DA, Kerns RD, Moore BA, Oberleitner L, Madden LM, Liong C, Ginn J, Schottenfeld RS. An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain. Drug Alcohol Depend 2019; 194:460-467. [PMID: 30508769 PMCID: PMC6312460 DOI: 10.1016/j.drugalcdep.2018.10.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 12/28/2022]
Abstract
AIMS The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy. METHODS In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19). RESULTS Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on 1-7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p < .001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald χ2 (1) = 5.47, p = .02]; time effects (p = .69) and interaction effects between treatment condition and time (p = .10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [χ2 (1, N = 40) = 0.002, p = 0.96]) did not differ significantly for patients assigned to CBT or MDC. CONCLUSIONS We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.
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Affiliation(s)
- Declan T Barry
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States.
| | - Mark Beitel
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States
| | - Christopher J Cutter
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States
| | - David A Fiellin
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, 06519, United States
| | - Robert D Kerns
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; VA Connecticut Healthcare System, West Haven, CT, 06516, United States
| | - Brent A Moore
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; VA Connecticut Healthcare System, West Haven, CT, 06516, United States
| | - Lindsay Oberleitner
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States
| | - Lynn M Madden
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, 06511, United States; APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States
| | - Christopher Liong
- APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States
| | - Joel Ginn
- APT Foundation Pain Treatment Services, New Haven, CT, 06519, United States
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The association between physical pain and cannabis use in daily life: An experience sampling method. Drug Alcohol Depend 2018; 191:294-299. [PMID: 30165330 DOI: 10.1016/j.drugalcdep.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous research shows that between individuals there is a positive association between medically motivated use and cannabis use frequency and quantity. While between-subjects' analyses are useful for understanding shared vulnerabilities, research has so far not examined within-subjects' relationships which are closer to evaluating functional relationships (i.e., do individuals tend to use cannabis more heavily subsequent to elevations in pain experiences?). To better understand the association between experiences of pain and cannabis use, the current paper examines whether there is a functional within-subjects association between experiences of pain and heavy cannabis use. METHODS 182 regular cannabis users without a medical cannabis license were asked to report momentary experiences of physical pain, whether they had used cannabis, and if so, quantity consumed five times per day over a five-day period on their smartphones. Mixed effects models examined the relations between within- and between-subjects experiences of pain and cannabis use and quantity consumed. RESULTS Elevated experiences of pain were not associated with cannabis use occasions at the within- or between-subjects level. Experiences of pain were associated with greater amount of cannabis consumed at the within-subjects level, but not at the between-subjects level. CONCLUSIONS Experiences of pain are not associated with decisions about whether or not to use cannabis. Once cannabis users are in cannabis-using situations, they tend to use larger amounts when they are experiencing elevated levels of pain. This may have implications for cannabis abuse treatment as pain may make it more difficult for users to reduce their consumption.
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Diversity in the Needs and Outcomes of Low-Threshold/High-Tolerance Methadone Maintenance Therapy Clients. CANADIAN JOURNAL OF ADDICTION 2017. [DOI: 10.1097/cxa.0000000000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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7
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Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. Pain 2017; 158:526-534. [PMID: 28192376 DOI: 10.1097/j.pain.0000000000000796] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Several factors may accelerate opioid discontinuation rates, including lack of information about the long-term effectiveness of opioids for chronic pain, heightened awareness about opioid-related adverse events, closer monitoring of patients for opioid-related aberrant behaviors, and greater restrictions around opioid prescribing. Rates of discontinuation may be most pronounced in patients deemed to be at "high risk." The purpose of this study was to compare reasons for discontinuation of long-term opioid therapy (LTOT) between patients with and without substance use disorder (SUD) diagnoses receiving care within a major U.S. health care system. This retrospective cohort study assembled a cohort of Veterans Health Administration patients prescribed opioid therapy for at least 12 consecutive months who subsequently discontinued opioid therapy for at least 12 months. From this cohort, we randomly selected 300 patients with SUD diagnoses and propensity score-matched 300 patients without SUD diagnoses. A comprehensive manual review of patients' medical records ascertained reasons for LTOT discontinuation. Most patients (85%) were discontinued as a result of clinician, rather than patient, decisions. For patients whose clinicians initiated discontinuation, 75% were discontinued because of opioid-related aberrant behaviors. Relative to patients without SUD diagnoses, those with SUD diagnoses were more likely to discontinue LTOT because of aberrant behaviors (81% vs 68%), most notably abuse of alcohol or other substances. This is the first study to document reasons for discontinuation of LTOT in a sample of patients with and without SUD diagnoses. Treatments that concurrently address SUD and chronic pain are needed for this high-risk population.
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Ilgen MA, Bohnert ASB, Chermack S, Conran C, Jannausch M, Trafton J, Blow FC. A randomized trial of a pain management intervention for adults receiving substance use disorder treatment. Addiction 2016; 111:1385-93. [PMID: 26879036 DOI: 10.1111/add.13349] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/22/2015] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Chronic pain is difficult to treat in individuals with substance use disorders and, when not resolved, can have a negative impact on substance use disorder treatment outcomes. This study tested the efficacy of a psychosocial pain management intervention, ImPAT (improving pain during addiction treatment), that combines pain management with content related to managing pain without substance use. DESIGN Single-site, parallel-groups randomized controlled trial comparing ImPAT to a supportive psychoeducational control (SPC) condition; follow-up assessments occurred at 3, 6 and 12 months. SETTING The Ann Arbor VA Substance Use Disorder treatment program, USA. PARTICIPANTS Veterans Health Administration patients {n = 129; mean [standard deviation (SD)], age = 51.7 (9.5); 115 of 129 (89%) male; ImPAT (n = 65); SPC (n = 64)}. INTERVENTION ImPAT combines principles of cognitive-behavioral therapy and acceptance-based approaches to pain management with content related to avoiding the use of substances as a coping mechanism for pain. The SPC used a psychoeducational attention control treatment for alcoholism modified to cover other substances in addition to alcohol. MEASUREMENTS Primary: Pain intensity over 12 months; secondary: pain-related functioning, frequency of alcohol and drug use over 12 months. FINDINGS Primary: randomization to the ImPAT intervention versus SPC predicted significantly lower pain intensity {β [standard error (SE)] = -0.71 (0.29); 95% confidence interval (CI) = -1.29, -0.12}; secondary: relative to the SPC condition, those who received ImPAT also reported improved pain-related functioning [β (SE) = 0.27 (0.11); 95% CI = 0.05, 0.49] and lower frequency of alcohol consumption [β (SE) = -0.77; 95% CI = -1.34, -0.20]. No differences were found between conditions on frequency of drug use over follow-up. CONCLUSIONS For adults with pain who are enrolled in addictions treatment, receipt of a psychological pain management intervention (improving pain during addiction treatment) reduced pain and alcohol use and improves pain-related functioning over 12 months relative to a matched-attention control condition.
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Affiliation(s)
- Mark A Ilgen
- VA Center for Clinical Management Research (CCMR), Veterans Health Administration, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- VA Center for Clinical Management Research (CCMR), Veterans Health Administration, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Chermack
- VA Center for Clinical Management Research (CCMR), Veterans Health Administration, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Carly Conran
- School of Literature, Science and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Mary Jannausch
- VA Center for Clinical Management Research (CCMR), Veterans Health Administration, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Trafton
- VA Program Evaluation and Resource Center (PERC), Veterans Health Administration, Menlo Park, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Frederic C Blow
- VA Center for Clinical Management Research (CCMR), Veterans Health Administration, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Morasco BJ, Greaves DW, Lovejoy TI, Turk DC, Dobscha SK, Hauser P. Development and Preliminary Evaluation of an Integrated Cognitive-Behavior Treatment for Chronic Pain and Substance Use Disorder in Patients with the Hepatitis C Virus. PAIN MEDICINE 2016; 17:2280-2290. [PMID: 28025362 DOI: 10.1093/pm/pnw076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Individuals with the hepatitis C virus (HCV) have high rates of both chronic pain and substance use disorder (SUD). Despite high comorbidity, there are limited data available on effective methods of treatment for co-occurring chronic pain and SUD. In this study, we sought to develop and conduct preliminary testing of an integrated cognitive-behavior therapy (CBT) for chronic pain and SUD in patients with HCV. DESIGN Descriptive, including pretreatment, posttreatment, and follow-up testing. SETTING AND PATIENTS Outpatient clinic as part of one VA Medical Center. PARTICIPANTS Veterans with chronic pain, SUD, and HCV. INTERVENTION Eight-session integrated group CBT for chronic pain and SUD in patients with HCV. METHODS Participants completed standardized measures of pain, function, depression severity, and alcohol and substance use at baseline, post-treatment, and 3-month follow-up. RESULTS Generalized estimating equations identified improvements in pain interference, reducing cravings for alcohol and other substances, and decreasing past-month alcohol and substance use. The proportion of participants who met diagnostic criteria for current SUD demonstrated a four-fold decrease over the course of the study from 24% at baseline to 15% at post-treatment and 6% at 3-month follow-up. On response to a global impression of change, 94% of participants noted improvement from baseline. CONCLUSIONS Results from this pilot study suggest that a customized CBT for patients with both chronic pain and SUD (CBT-cp.sud) may be beneficial in improving important pain and addiction-related outcomes in patients with HCV. Larger scale investigations of this intervention appear warranted.
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Affiliation(s)
- Benjamin J Morasco
- *Center to Improve Veteran Involvement in Care .,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - David W Greaves
- Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Travis I Lovejoy
- *Center to Improve Veteran Involvement in Care.,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington, Seattle, Washington
| | - Steven K Dobscha
- *Center to Improve Veteran Involvement in Care.,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Peter Hauser
- VISN 22 Network Office and Division of Mental Health, Long Beach VA Medical Center, California.,Department of Psychiatry, University of California San Diego.,Department of Psychiatry and Human Behavior, University of California-Irvine, California, USA
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10
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Treatment Approaches for Patients With Opioid Use Disorder and Chronic Noncancer Pain: a Literature Review. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KMG. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther 2016; 45:5-31. [DOI: 10.1080/16506073.2015.1098724] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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12
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Cosio D. Practice-based evidence for outpatient, acceptance & commitment therapy for veterans with chronic, non-cancer pain. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2016. [DOI: 10.1016/j.jcbs.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Ashrafioun L, Bohnert ASB, Jannausch M, Ilgen MA. Evaluation of the current opioid misuse measure among substance use disorder treatment patients. J Subst Abuse Treat 2015; 55:15-20. [PMID: 25800105 PMCID: PMC4456230 DOI: 10.1016/j.jsat.2015.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/02/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
The Current Opioid Misuse Measure (COMM) has demonstrated promising psychometric properties among pain clinic and primary care patients. Given the high prevalence of the nonmedical use of prescription opioids among substance use disorder patients, the COMM may also be useful in substance use disorder treatment settings. The purpose of this study was to assess the factor structure and validity of the COMM in a sample of substance use disorder patients. Participants (n = 351) were recruited from a large residential substance use disorder treatment center and completed the COMM and several questionnaires assessing various substance use and health functioning characteristics. Factor analyses yielded a two-factor solution; however, each of the items in the second factor cross-loaded onto the first factor and just one factor was retained. To provide support for this new 11-item COMM, we found that higher scores on this COMM were associated with greater drug use severity, greater endorsement of positive, negative, and pain relief outcome expectancies related to opioid use, increased pain intensity, and decreased physical and mental health functioning. These findings provide initial support for the psychometric properties of this version of the COMM adapted for substance use disorder treatment settings. Given its promising psychometric properties, the 11 items of the COMM to evaluate the nonmedical use of prescription opioids have potential utility among substance use disorder patients. The COMM could be used to examine nonmedical use over the course of treatment and to aid treatment planning. It could also be used in research as an outcome measure.
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Affiliation(s)
- Lisham Ashrafioun
- Bowling Green State University, Department of Psychology, 207 Psychology Building, Bowling Green, OH 43403; VA Ann Arbor Healthcare System, Mental Health Service, 2215 Fuller Rd., Ann Arbor, MI 48105.
| | - Amy S B Bohnert
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Department of Veterans Affairs Healthcare System, Ann Arbor MI, North Campus Research Complex, 2800 Plymouth Rd Building 14, Ann Arbor, MI 48109; Department of Psychiatry, University of Michigan, Ann Arbor, MI, North Campus Research Complex, 2800 Plymouth Rd Building 10, Ann Arbor, MI 48109
| | - Mary Jannausch
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Department of Veterans Affairs Healthcare System, Ann Arbor MI, North Campus Research Complex, 2800 Plymouth Rd Building 14, Ann Arbor, MI 48109; Department of Psychiatry, University of Michigan, Ann Arbor, MI, North Campus Research Complex, 2800 Plymouth Rd Building 10, Ann Arbor, MI 48109
| | - Mark A Ilgen
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Department of Veterans Affairs Healthcare System, Ann Arbor MI, North Campus Research Complex, 2800 Plymouth Rd Building 14, Ann Arbor, MI 48109; Department of Psychiatry, University of Michigan, Ann Arbor, MI, North Campus Research Complex, 2800 Plymouth Rd Building 10, Ann Arbor, MI 48109
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Zale EL, Maisto SA, Ditre JW. Interrelations between pain and alcohol: An integrative review. Clin Psychol Rev 2015; 37:57-71. [PMID: 25766100 PMCID: PMC4385458 DOI: 10.1016/j.cpr.2015.02.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
Abstract
Pain and alcohol use are both highly prevalent in the general population, and pain-alcohol interrelations are of increasing empirical interest. Previous research has identified associations between pain and alcohol dependence, and the current review provides novel contributions to this emerging domain by incorporating studies that have tested relations between pain and low-to-moderate alcohol consumption, and by identifying potential psychosocial mechanisms of action. Specifically, we sought to integrate evidence of pain-alcohol relations derived from two directions of empirical inquiry (i.e., effects of alcohol on pain and effects of pain on alcohol use) across psychological, social, and biological literatures. We observed converging evidence that associations between alcohol consumption and pain may be curvilinear in nature. Whereas moderate alcohol use was observed to be associated with positive pain-related outcomes (e.g., greater quality of life), excessive drinking and alcohol use disorder appear to be associated with deleterious pain-related outcomes (e.g., greater pain severity). We also observed evidence that alcohol administration confers acute pain-inhibitory effects, and that situational pain may motivate alcohol consumption (e.g., drinking for pain-coping). Future research can inform theoretical and clinical applications through examination of temporal relations between pain and alcohol consumption, tests of hypothesized mechanisms, and the development of novel interventions.
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Affiliation(s)
- Emily L Zale
- Syracuse University, Syracuse, NY 13244, United States
| | - Stephen A Maisto
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States
| | - Joseph W Ditre
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States.
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Barry DT, Savant JD, Beitel M, Cutter CJ, Schottenfeld RS, Kerns RD, Moore BA, Oberleitner L, Joy MT, Keneally N, Liong C, Carroll KM. The feasibility and acceptability of groups for pain management in methadone maintenance treatment. J Addict Med 2014; 8:338-44. [PMID: 25100310 PMCID: PMC4177009 DOI: 10.1097/adm.0000000000000055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Effective and safe pain management interventions in methadone maintenance treatment are needed. METHODS We examined the feasibility (ie, single-session attendance) and acceptability (ie, patient satisfaction and booster session attendance) of cognitive-behavioral therapy-informed groups for pain management-Coping With Pain, Relaxation Training, Group Singing, and Mindful Walking. Pre- and postsession measures were collected. RESULTS A total of 349 (out of a census of approximately 800) methadone-maintained patients attended at least 1 of the groups. Group satisfaction was high. Booster session attendance was numerically lower in Mindful Walking (14%) than in the other groups (at least 40%). Repeat attendance at Coping With Pain was associated with reduced characteristic pain intensity and depression, whereas repeat attendance at Relaxation Training was associated with decreased anxiety. CONCLUSIONS Coping With Pain, Relaxation Training, and Group Singing are transportable, affordable, adaptable, and tolerated well by patients with pain and show promise as components of a multimodal pain management approach in methadone maintenance treatment.
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Affiliation(s)
- Declan T. Barry
- Yale University School of Medicine, New Haven, CT
- APT Foundation Pain Treatment Services, New Haven, CT
| | | | - Mark Beitel
- Yale University School of Medicine, New Haven, CT
- APT Foundation Pain Treatment Services, New Haven, CT
| | - Christopher J. Cutter
- Yale University School of Medicine, New Haven, CT
- APT Foundation Pain Treatment Services, New Haven, CT
| | | | - Robert D. Kerns
- Yale University School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Lindsay Oberleitner
- Yale University School of Medicine, New Haven, CT
- APT Foundation Pain Treatment Services, New Haven, CT
| | | | - Nina Keneally
- APT Foundation Pain Treatment Services, New Haven, CT
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Morasco BJ, Lovejoy TI, Turk DC, Crain A, Hauser P, Dobscha SK. Biopsychosocial factors associated with pain in veterans with the hepatitis C virus. J Behav Med 2013; 37:902-11. [PMID: 24338521 DOI: 10.1007/s10865-013-9549-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 12/06/2013] [Indexed: 01/06/2023]
Abstract
Little research has examined etiological factors associated with pain in patients with the hepatitis C virus (HCV). The purpose of this study was to evaluate the relationship between biopsychosocial factors and pain among patients with HCV. Patients with HCV and pain (n = 119) completed self-report measures of pain, mental health functioning, pain-specific psychosocial variables (pain catastrophizing, self-efficacy for managing pain, social support), prescription opioid use, and demographic characteristics. In multivariate models, biopsychosocial factors accounted for 37% of the variance in pain severity and 56% of the variance in pain interference. In adjusted models, factors associated with pain severity include pain catastrophizing and social support, whereas variables associated with pain interference were age, pain intensity, prescription opioid use, and chronic pain self-efficacy (all p values <0.05). The results provide empirical support for incorporating the biopsychosocial model in evaluating and treating chronic pain in patients with HCV.
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Affiliation(s)
- Benjamin J Morasco
- Mental Health and Clinical Neurosciences Division, Portland VA Medical Center (R&D99), 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA,
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Elander J, Duarte J, Maratos FA, Gilbert P. Predictors of painkiller dependence among people with pain in the general population. PAIN MEDICINE 2013; 15:613-24. [PMID: 24152117 DOI: 10.1111/pme.12263] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Self-medication with painkillers is widespread and increasing, and evidence about influences on painkiller dependence is needed to inform efforts to prevent and treat problem painkiller use. DESIGN Online questionnaire survey. PARTICIPANTS People in the general population who had pain and used painkillers in the last month (N = 112). MEASUREMENTS Pain frequency and intensity, use of over-the-counter and prescription painkillers, risk of substance abuse (Screener and Opioid Assessment for Patients with Pain [SOAPP] scale), depression, anxiety, stress, alexithymia, pain catastrophizing, pain anxiety, pain self-efficacy, pain acceptance, mindfulness, self-compassion, and painkiller dependence (Leeds Dependence Questionnaire). RESULTS In multiple regression, the independent predictors of painkiller dependence were prescription painkiller use (β 0.21), SOAPP score (β 0.31), and pain acceptance (β -0.29). Prescription painkiller use mediated the influence of pain intensity. Alexithymia, anxiety, and pain acceptance all moderated the influence of pain. CONCLUSIONS The people most at risk of developing painkiller dependence are those who use prescription painkillers more frequently, who have a prior history of substance-related problems more generally, and who are less accepting of pain. Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain, and 3) psychological factors related to pain. The model could guide further research among the general population and high-risk groups, and acceptance-based interventions could be adapted and evaluated as methods to prevent and treat painkiller dependence.
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Abstract
OBJECTIVES We investigated possible associations between pain frequency and the 5 most common substance use disorders: alcohol abuse/dependence, cocaine abuse/dependence, methamphetamine abuse/dependence, opioid abuse/dependence, and marijuana abuse/dependence. METHODS We used data from the Rural Stimulant Study, a longitudinal (7 waves), observational study of at-risk stimulant users (cocaine and methamphetamine) in Arkansas and Kentucky (n=462). In fixed-effects logistic regression models, we regressed our measures of substance use disorders on the number of days with pain in the past 30 days and depression severity. RESULTS Time periods when individuals had 1 to 15 days [odds ratio (OR)=1.85, P<0.001] or 16+ days (OR=2.18, P<0.001) with pain in the past 30 days were more likely to have a diagnosis of alcohol abuse/dependence, compared with time periods when individuals had no days with pain. Compared with time periods when individuals had no pain days in the past 30 days, time periods when individuals had 16+ pain days were more likely to have a diagnosis of opioid abuse/dependence (OR=3.32, P=0.02). Number of days with pain was not significantly associated with other substance use disorders. DISCUSSION Pain frequency seems to be associated with an increased risk for alcohol abuse/dependence and opioid abuse/dependence in this population, and the magnitude of the association is medium to large. Further research is needed to investigate this in more representative populations and to determine causal relationships.
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Affiliation(s)
- Mark J. Edlund
- Behavioral Health Epidemiology, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6560 Seattle, WA 98195-6560
| | - Xiaotong Han
- Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, 4310 W Markham St Slot 755, Little Rock, AR 72205
| | - Brenda M. Booth
- Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, 4310 W Markham St Slot 755, Little Rock, AR 72205
- Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, Bldg 58, North Little Rock, AR 72114
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Bohnert ASB, Eisenberg A, Whiteside L, Price A, McCabe SE, Ilgen MA. Prescription opioid use among addictions treatment patients: nonmedical use for pain relief vs. other forms of nonmedical use. Addict Behav 2013; 38:1776-81. [PMID: 23254228 PMCID: PMC4049343 DOI: 10.1016/j.addbeh.2012.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 09/10/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Differences between those who engage in nonmedical prescription opioid use for reasons other than pain relief and those who engage in nonmedical use for reasons related to pain only are not well understood. METHODS Adults in a residential treatment program participated in a cross-sectional self-report survey. Participants reported whether they used opioids for reasons other than pain relief (e.g., help sleep, improve mood, or relieve stress). Within those with past-month nonmedical opioid use (n=238), logistic regression tested differences between those who reported use for reasons other than pain relief and those who did not. RESULTS Nonmedical use of opioids for reasons other than pain relief was more common (66%) than nonmedical use for pain relief only (34%), and those who used for reasons other than pain relief were more likely to report heavy use (43% vs. 11%). Nonmedical use for reasons other than pain relief was associated with having a prior overdose (odds ratio [OR]=2.54, 95% CI: 1.36-4.74) and use of heroin (OR=4.08, 95% CI: 1.89-8.79), barbiturates (OR=6.44, 95% CI: 1.47, 28.11), and other sedatives (OR=5.80, 95% CI: 2.61, 12.87). Individuals who reported nonmedical use for reasons other than pain relief had greater depressive symptoms (13.1 vs. 10.5) and greater pain medication expectancies across all three domains (pleasure/social enhancement, pain reduction, negative experience reduction). CONCLUSIONS Among patients in addictions treatment, individuals who report nonmedical use of prescription opioids for reasons other than pain relief represent an important clinical sub-group with greater substance use severity and poorer mental health functioning.
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Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Resource and Evaluation Center and VA Health Services Research and Development, North Campus Research Complex, 2800 Plymouth Road, Building 14, Ann Arbor, MI 48109, USA.
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Abstract
Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. For providers who treat pain, this has led to clinical dilemmas as the newly appreciated risks must be balanced with the benefits of treatment, particularly in patients with known substance use disorders. Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.
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Affiliation(s)
- Daniel Krashin
- Anesthesiology and Pain Medicine, University of Washington Medical Center, Box 354692, 1959 NE Pacific, Seattle, WA 98195, USA.
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21
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Pain anxiety, acceptance, and outcomes among individuals with HIV and chronic pain: A preliminary investigation. Behav Res Ther 2012; 50:72-8. [DOI: 10.1016/j.brat.2011.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 09/06/2011] [Accepted: 10/21/2011] [Indexed: 11/21/2022]
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